New Cervical Cancer Screening Recommendations

Dec. 1, 2009 – The Pap smear is a standard screening tool that has saved countless women from cervical cancer. While the test can be lifesaving, overtesting can hurt women, according to the American College of Obstetricians and Gynecologists. The group recently released new recommendations for cervical cancer screening. In this episode of Cancer Connection, Siteman Cancer Center gynecologic oncologist L. Steward Massad, MD, talks about the guidelines.

On this edition of Cancer Connection, find out about new recommendations that say annual cervical cancer screenings are no longer necessary.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill. The American College of Obstetricians and Gynecologists has issued new guidelines for cervical cancer screenings. To tell us about them is L. Stewart Massad, MD, a gynecologic oncologist at the Siteman Cancer Center. Dr. Massad, thank you for joining us.

Massad: Thank you. It’s a privilege to be here.

Host: So what are the recommendations?

Massad: The new guidelines from the American College of Obstetricians and Gynecologists change our approach to cervical cancer screening and prevention by allowing us to screen women less frequently than we used to. That’s the core of the change. The details are that we will start screening now at age 21. The previous guideline had been at age 21 or three years after first intercourse. The reason for that was to catch women who had a papillomavirus infection after allowing it some time to regress. Now we realize that adolescents don’t get cervical cancer. The risk is only about three per million. So we won’t be missing cancers by not screening women in their teens. And the rate of cervical cancer precursors and papillomavirus infections is as high as 20 percent in teens. So the rate of abnormality is high, and we know that there is a downside to screening in that women who get treated for cervical lesions that are fated to go away can have a higher rate of preterm delivery, which for an adolescent is a big threat.

Host: Why were the guidelines changed?

Massad: They were changed in recognition of the problems that we were encountering from overscreening. Most cervical cancer precursors are caused by human papillomavirus, which is a sexually transmitted infection. As you can imagine, giving a woman a diagnosis of a papillomavirus infection can disrupt relationships. It can cause her to feel ashamed or stigmatized. But most fundamentally, it can lead to treatment of lesions that are fated to go away. Especially in adolescents, more than 90 percent of papillomavirus infections and early precancerous lesions will be cleared by a woman’s immune system. By allowing women time to have their immune systems act on the papillomavirus infection, we minimize the likelihood that we’re going to find trivial lesions that will regress over time.

Host: There are other changes?

Massad: We should screen women less often. Previously it had been optional to screen women at longer intervals, but most clinicians still hung on to screening once a year. Now the recommendation is between ages 20 and 29, to screen only every other year, and for women between the ages of 30 and 65 to 70, to screens only every three years. That’s provided those women don’t have previous high-grade cervical dysplasia or cancer and have good functioning immune systems.

Host: This comes on the heels of the breast cancer recommendations that were made by an independent task force. Your recommendations come from a professional group that studies Pap smears and has – you could argue – a better sense of why this is a good idea, correct?

Massad: These guidelines come from the American College of Obstetricians and Gynecologists, which is the national organization for ob/gyn clinicians in the United States. As such, they’re closer to the street than the U.S. Preventive Services Task Force and are more sensitive to the concerns of women and the primary providers who do the Pap screening. But nevertheless, the evidence was pretty clear that annual Pap testing for everyone starting soon after first intercourse results in more harm than benefit.

Host: Overall, what’s the advice you want to get to women about these new recommendations?

Massad: That Pap testing is an important aspect of preventive care and that it can be lifesaving, but overtesting can hurt them. One thing that the college had said in the past but has put new emphasis on is the concept that women who have had a hysterectomy for reasons other than cancer or precancer don’t need to have any further Pap testing.

Host: How important for women is it to get Pap smears?

Massad: More than half of the cervical cancers diagnosed in the United States occur in women who are underscreened, either women who haven’t been screened or who haven’t been screened in a long time. It’s clearly a preventable cancer. The message should be that screening should continue but it doesn’t need to happen as often as it used to.

Host: Dr. Massad, thank you for joining us.

Massad: You’re very welcome.

Host: For more information about cervical cancer, visit www.siteman.wustl.edu or call 800-600-3606. Thanks for downloading. Until next time, I’m Jason Merrill.